Neurosurgery
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Review Case Reports
Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report.
The use of chronic intrathecal morphine for the treatment of intractable, nonmalignant pain is becoming more prevalent. A rare but devastating complication of this therapy is the development of spinal cord compression secondary to the formation of intrathecal granulomas. ⋯ Intrathecal granulomas are likely to occur with increasing frequency as the use of chronic intrathecal morphine delivery increases in patients with nonmalignant pain. The cause of intrathecal granulomas is unknown, although it is likely that morphine plays a major role in their formation. We think that those patients receiving high doses of morphine are at greater risk for developing this complication.
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Comparative Study
Comparison of brain temperature with bladder and rectal temperatures in adults with severe head injury.
The purpose of this study was to compare brain temperature (Tbr) with conventional indicators of core body temperature (i.e., rectal temperature [Tre] and bladder temperature [Tbl]), in adults with severe head injury. ⋯ Tbl and Tre often underrepresent Tbr after traumatic brain injury, particularly when the patient is hypo- or hyperthermic.
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By conducting a review of clinical outcomes for patients with aneurysms treated using current microneurosurgical techniques and intensive care unit management, we determined that grading systems based only on the clinical condition of the patient failed to produce a significant stratification of outcome between individual grades of patients. We hypothesized that outcome prediction for patients surgically treated for intracranial aneurysms could be improved by including factors other than clinical condition that were also strongly associated with outcome. ⋯ This new grading system is easy to apply, separates patients into groups with markedly different outcomes, and is comprehensive, allowing for more accurate prediction of surgical outcome for both unruptured and ruptured cerebral aneurysms.
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Dural sinus thrombosis has rarely been associated with closed head injury. We present a unique case involving the use of endovascular thrombolysis in the treatment of traumatic dural sinus thrombosis, which has not been reported. ⋯ This case documents a rare instance of traumatic dural sinus thrombosis resulting from a closed head injury. In addition, endovascular thrombolysis resulted in subsequent opening of the dural sinuses and effective intracranial pressure management, despite the presence of a hemorrhagic contusion. Heparin was effective in maintaining sinus patency and was used safely in conjunction with urokinase in this setting of head injury.
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In some patients with moyamoya disease, the development of spontaneous leptomeningeal collateral channels between the anterior cerebral artery (ACA) and other major arteries is poor. These patients require revascularization not only to the territory of the middle cerebral artery (MCA) but also to that of the ACA. For reliable revascularization to the ACA territory, we performed superficial temporal artery (STA)-ACA direct anastomosis in 5 of 58 patients with moyamoya disease who underwent cerebral revascularization at our institute during the last 8 years. ⋯ Our method using a cortical branch of the ACA as a recipient and a branch of the STA for the interposed graft can be performed at the convexity and much more easily than in a deep operative field. Our experience with STA-ACA anastomosis indicates that this procedure is effective for revascularization of the ACA territory in patients with moyamoya disease.